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Hospitals in a public fight with doctors over work reform

In an unusual public battle, the gloves have come off between Ontario hospitals and doctors, with one group accusing the other of protecting its turf and obstructing reform.

At issue is Bill 179, which would let non-physicians do some of the work doctors currently perform. The Ontario Medical Association, the doctors' lobby, is fighting government plans to let nurse practitioners lead local health clinics and to allow pharmacists to prescribe some medications.

The Ontario Hospital Association supports the proposed changes and charges that the OMA is more interested in turf protection than in changes that would improve access to health care while allowing doctors to focus time and talents on more complex cases.

"The (medical association), in our opinion, has a recent history of being opposed to significant health system change," Tom Closson, president of the hospital association, charged in a recent interview.

The war of words has recently erupted in the op-ed pages of the Toronto Star, with the OMA president, Dr. Suzanne Strasberg, writing that Closson's assertion that doctors aren't providing leadership is insulting.

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Dr. Michael Rachlis, a private health policy consultant, observed that while the two organizations have had disagreements in the past, their differences have never spilled over so publicly before.

"It's unusual in the health policy landscape to have the OMA and the OHA go at it in public like that," he said, adding that the OMA's position isn't finding much resonance in the health sector.

"The OMA seems very offside compared to everyone else," he said.

Rachlis said the OMA section on general and family practice fanned the flames when it launched an aggressive ad campaign, warning that patient safety would be risked unless physicians reviewed the diagnosis and treatment decisions of nurse practitioners. The ads also questioned whether pharmacists have the necessary education and training to prescribe certain drugs.

Rachlis called the ads offensive: "When doctors go out and scare the public (by saying) that being a nurse or a pharmacist could be dangerous to your health, I have to check which decade I'm living in."

The campaign shows that the OMA is "very out of step with its younger members," he charged, noting that physicians coming out of medical school today are trained to work in teams with other health professionals, all of whom practise to the full scope of their expertise.

Closson also accused the OMA of being out of touch with its members.

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Strasberg denied that charge, pointing out that the OMA's approval rate was almost 70 per cent last year in an annual satisfaction survey of its 26,000 active members.

She said doctors are very much in favour of the team approach to providing health care to patients and noted that she works as a family doctor at Jane and Finch with a team that includes a nurse, chiropodist, dietitian and social worker.

"What we don't want to see are silos of health care being provided such as nurse-led independent clinics," she said. "We think that all health-care providers should work together under one roof. That way we all know the patient well and we can all provide the patient with the best quality of care that's available. That's the goal of Ontario's doctors."

That wasn't always the case. Not that long ago, the OMA lobbied against the team approach to providing primary care.

"Doctors have come a long way in the last four to five years. If you ask most doctors out there today, they want to work in teams," Strasberg said.

Closson emphasized that his criticisms were directed not at front-line doctors but the OMA, which he describes as a "union."

When the province is faced with a growing deficit and health-care costs are growing at an unsustainable rate, major reform is necessary, he said.

NDP health critic France Gélinas, who supports Bill 179, credited Closson for taking on the OMA. Both nurses and pharmacists have made noise about the OMA, but because they have a vested interest in Bill 179, Closson's words have more bearing, she said.

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